Chemotherapy and Cardiotoxicity: advances and challenges in cardio-oncology – An integrative review
DOI:
https://doi.org/10.33448/rsd-v14i8.49310Keywords:
Cardiotoxicity, Antineoplastic Agents, Cardio-oncology.Abstract
Introduction: The exponential increase in cancer cases has had a widespread impact, culminating in the advancement of drugs and chemotherapies involved in treatment. Among the most commonly used pharmacological classes are anthracyclines and anti-HER2 agents, with doxorubicin and trastuzumab being the main examples, respectively. These drugs are frequently described with a causal association with chemotherapy-induced cardiotoxicity. Cardiotoxicity is defined as the confirmed presence of a new cardiovascular alteration during or after treatment without other possible etiological causes to justify the condition. This represents a significant complication during cancer treatment, highlighting the importance of the cardio-oncologist’s involvement in the early identification of cardiovascular involvement, its monitoring, and treatment. Objective: To establish an updated review on the topic of cardiotoxicity related to chemotherapeutic agents, trastuzumab and doxorubicin, and the importance of developing prevention and treatment strategies. Methodology: A non-experimental, descriptive research will be conducted, through an integrative literature review of articles found on the official websites of PubMed® and SciELO®, available between the years 2018 and 2024, and publicly accessible. Conclusion: It is concluded that there is no doubt regarding the relationship between chemotherapeutic agents and cardiotoxicity. The importance of regular cardiological follow-up through complementary exams is reinforced, aiming at early recognition and intervention to prevent irreversible cardiovascular damage.
References
A.C. Camargo Cancer Center. (2023). Observatório do câncer: Registro Hospitalar de Câncer do A.C.Camargo Cancer Center 2000 a 2020 (43 p.). Fundação Antônio Prudente. https://accamargo.org.br/sites/default/files/2023/04/observatorio_do_cancer_rhc_2000-2020.pdf
Abdel-Qadir, H., Thavendiranathan, P., Austin, P. C., Lee, D. S., Amir, E., Tu, J. V., et al. (2019). Development and validation of a multivariable prediction model for major adverse cardiovascular events after early-stage breast cancer: A population-based cohort study. European Heart Journal, 40(48), 3913–3920. https://doi.org/10.1093/eurheartj/ehz487
Adão, R., de Keulenaer, G., Leite-Moreira, A., & Brás-Silva, C. (2013). Cardiotoxicity associated with cancer therapy: Pathophysiology and prevention strategies. Revista Portuguesa de Cardiologia, 32(5), 395–409. https://doi.org/10.1016/j.repc.2012.11.002
Agunbiade, T. A., Zaghlol, R. Y., & Barac, A. (2019). Heart failure in relation to anthracyclines and other chemotherapies. Methodist DeBakey Cardiovascular Journal, 15(4), 243. https://doi.org/10.14797/mdcj-15-4-243
Ala, C. K., Klein, A. L., & Moslehi, J. J. (2019). Cancer treatment-associated pericardial disease: Epidemiology, clinical presentation, diagnosis, and management. Current Cardiology Reports, 21(12), 156. https://doi.org/10.1007/s11886-019-1217-0
Albini, A., Pennesi, G., Donatelli, F., et al. (2010). Cardiotoxicity of anticancer drugs: The need for cardio-oncology and cardio-oncological prevention. Journal of the National Cancer Institute, 102(1), 14–25. https://doi.org/10.1093/jnci/djp440
Alencar Filho, A. C., & Gonçalves, M. J. F. (2011). Metassínteses qualitativas e revisões integrativas: Cardiologia e oncologia: Uma visão interdisciplinar. Saúde & Transformação Social, 1(2), 150–154.
American Cancer Society. (2021). Cancer statistics 2021. CA: A Cancer Journal for Clinicians, 71(1), 7–30. https://doi.org/10.3322/caac.21341
Ananthan, K., & Lyon, A. R. (2020). The role of biomarkers in cardio-oncology. Journal of Cardiovascular Translational Research, 13(4), 431–450. https://doi.org/10.1007/s12265-020-09990-6
Armenian, S. H., Yang, D., Teh, J. B., Atencio, L. C., Gonzales, A., Wong, F. L., et al. (2018). Prediction of cardiovascular disease among hematopoietic cell transplantation survivors. Blood Advances, 2(14), 1756–1764. https://doi.org/10.1182/bloodadvances.2018007792
Armenian, S., & Bhatia, S. (2018). Predicting and preventing anthracycline-related cardiotoxicity. American Society of Clinical Oncology Educational Book, 38, 3–12.
Ávila, M. S., Siqueira, S. R. R., Waldeck, L., Ayub-Ferreira, S. M., Takx, R., Bittencourt, M. S., et al. (2023). Antagonistas do sistema renina-angiotensina e beta-bloqueadores na prevenção da cardiotoxicidade induzida por antraciclinas: Uma revisão sistemática e meta-análise. Arquivos Brasileiros de Cardiologia, 120(5), e20220298. https://doi.org/10.36660/abc.20220298
Barish, R., Lynce, F., Unger, K., & Barac, A. (2019). Management of cardiovascular disease in women with breast cancer. Circulation, 139, 1110–1120. https://doi.org/10.1161/CIRCULATIONAHA.118.039371
Battisti, N. M. L., Andres, M. S., Lee, K. A., Ramalingam, S., Nash, T., Mappouridou, S., et al. (2021). Incidence of cardiotoxicity and validation of the Heart Failure Association–International Cardio-Oncology Society risk stratification tool in patients treated with trastuzumab for HER2-positive early breast cancer. Breast Cancer Research and Treatment, 188(1), 149–163. https://doi.org/10.1007/s10549-021-06121-4
Ben Kridis, W., Sghaier, S., Charfeddine, S., Toumi, N., Daoud, J., Kammoun, S., et al. (2020). A prospective study about trastuzumab-induced cardiotoxicity in HER2-positive breast cancer. American Journal of Clinical Oncology: Cancer Clinical Trials, 43(6), 510–516. https://doi.org/10.1097/COC.0000000000000711
Berenguer, D. R. F., Becker, M. M. C., Buril, R. O., Bertão, P. A., Markman Filho, B., & Brandão, S. C. S. (2024). Evolução da captação miocárdica de 18F-FDG em paciente com diagnóstico de cardiotoxicidade. Arquivos Brasileiros de Cardiologia, 121(2), e20230276. https://doi.org/10.36660/abc.20230276
Borde, C., Kand, P., & Basu, S. (2012). Enhanced myocardial fluorodeoxyglucose uptake following adriamycin-based therapy: Evidence of early chemotherapeutic cardiotoxicity? World Journal of Radiology, 4(5), 220–223. https://doi.org/10.4329/wjr.v4.i5.220
Brant, L. C. C., et al. (2017). Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015: Estimates from the Global Burden of Disease. Revista Brasileira de Epidemiologia, 20(Suppl. 1), 116–128.
Cameron, D., Piccart-Gebhart, M. J., Gelber, R. D., Procter, M., Goldhirsch, A., de Azambuja, E., et al. (2017). 11 years' follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: Final analysis of the HERceptin Adjuvant (HERA) trial. Lancet, 389(10075), 1195–1205. https://doi.org/10.1016/S0140-6736(17)30468-9
Cardinale, D., Colombo, A., Bacchiani, G., Tedeschi, I., Meroni, C. A., Veglia, F., et al. (2015). Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation, 131(22), 1981–1988. https://doi.org/10.1161/CIRCULATIONAHA.114.013777
Crossetti, M. G. O. (2012). Revisão integrativa de pesquisa na enfermagem: O rigor científico que lhe é exigido. Revista Gaúcha de Enfermagem, 33(2), 8–13. http://hdl.handle.net/10183/94920
Esquvias, G. B., & Asteggiano, R. (2015). Cardiac management of oncology patients: Clinical handbook for cardio-oncology. Springer. https://doi.org/10.1007/978-3-319-15808-2
European Society of Cardiology. (2022). 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO), and the International Cardio-Oncology Society (IC-OS). European Heart Journal, 43, 4229–4361. https://doi.org/10.1093/eurheartj/ehac244
Ewer, M. S., & Ewer, S. M. (2015). Cardiotoxicity of anti-cancer treatments. Nature Reviews Cardiology, 12(9), 547–558. https://doi.org/10.1038/nrcardio.2015.84
Ewer, M. S., et al. (2005). Reversibility of trastuzumab-related cardiotoxicity: New insights based on clinical course and response to medical treatment. Journal of Clinical Oncology, 23(31), 7820–7826. https://doi.org/10.1200/JCO.2005.13.300
Fava, M. G., Furtado, R. H. M., & Polanczyk, C. A. (2021). Uso de betabloqueadores na prevenção da cardiotoxicidade causada por antraciclinas: Revisão sistemática e meta-análise. Arquivos Brasileiros de Cardiologia, 117(3), 493–504. https://doi.org/10.36660/abc.20200481
Ferreira, M. B., Silva, P. C., & Sanna, G. M. P. (2017). Cardiopatia isquêmica na paciente oncológica: A importância da prevenção. Arquivos Brasileiros de Cardiologia, 109(5), 504–510. https://doi.org/10.5935/abc.20170074
Gil, A. C. (2017). Métodos e técnicas de pesquisa social (7ª ed.). Editora Atlas.
Gonzaga, T. D., Silva, M. T. S., & Barbosa, F. M. (2018). Uso da ecocardiografia na avaliação da cardiotoxicidade por antraciclinas: Revisão sistemática. Revista Brasileira de Cancerologia, 64(4), 429–435. https://doi.org/10.32635/2176-9745.RBC.2018v64n4.733
Herrmann, J., et al. (2016). Evaluation and management of patients with heart disease and cancer: Cardio-oncology. Expert Review of Cardiovascular Therapy, 14(10), 1163–1173. https://doi.org/10.1586/14779072.2016.1201070
Keramida, K., & Varela, A. (2017). Cardiotoxicity in breast cancer treatments. Breast Cancer: Targets and Therapy, 9, 43–53. https://doi.org/10.2147/BCTT.S119952
Khan, S., et al. (2022). Cardiovascular complications of cancer therapy: A comprehensive review. Journal of the American College of Cardiology, 79(4), 337–350. https://doi.org/10.1016/j.jacc.2021.11.019
Larsen, A. I., Haugen, T. B., Aakhus, S., Kvaløy, S., Mjølstad, O. C., & Hagve, T. A. (2015). Predictors of trastuzumab-induced cardiotoxicity in breast cancer patients: A prospective study. European Journal of Heart Failure, 17(3), 324–330. https://doi.org/10.1002/ejhf.228
Lobato, J., & Brito, F. A. (2020). Cardiotoxicidade por quimioterapia: Atualização e monitoramento. Arquivos Brasileiros de Cardiologia, 114(5), 891–899. https://doi.org/10.36660/abc.20190212
Lu, J., Mills, G., & Elmore, J. (2020). Biomarkers for early detection of chemotherapy-induced cardiotoxicity. Journal of Clinical Oncology, 38(27), 3060–3068. https://doi.org/10.1200/JCO.20.00567
Menna, P., Salvatorelli, E., & Minotti, G. (2008). Cardiotoxicity of antitumor anthracyclines. Chemical Research in Toxicology, 21(8), 1437–1449. https://doi.org/10.1021/tx800177r
Moslehi, J. J. (2016). Cardiovascular toxic effects of targeted cancer therapies. The New England Journal of Medicine, 375(15), 1457–1467. https://doi.org/10.1056/NEJMra1100265
Nishimura, R. A., Tajik, A. J., & Bailey, K. R. (1997). Cardiotoxicity of chemotherapy. Current Problems in Cardiology, 22(11), 637–681. https://doi.org/10.1016/s0146-2806(97)80002-9
Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica [eBook gratuito]. Editora da UFSM. https://repositorio.ufsm.br/handle/1/1582
Pérez, J. M., et al. (2019). Cardiotoxicity of chemotherapy agents: Clinical presentation and management. Oncology Reports, 42(4), 1563–1572. https://doi.org/10.3892/or.2019.7237
Plana, J. C., et al. (2014). Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 27(9), 911–939. https://doi.org/10.1016/j.echo.2014.07.012
Trousseau, A. (1865). Phlegmasia alba dolens. Clinical Lectures on Surgical Subjects. London: Walton & Maberly.
Zamorano, J. L., Lancellotti, P., Rodriguez Muñoz, D., Aboyans, V., Asteggiano, R., Galderisi, M., et al. (2016). 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). European Heart Journal, 37(36), 2768–2801. https://doi.org/10.1093/eurheartj/ehw211
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Kênio Salgueiro Okamura, Géssica Dorta Souza, Isabella Ibrahim, Nathalia de Souza Fernandes, Flávia Helena Fornazeiro Abegão, Bruna de Souza Gameiro Jorge da Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
